1548395262 NPI number — COLUMBIA ADVANCED CHIROPRACTIC, LLC

Table of content: (NPI 1548395262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548395262 NPI number — COLUMBIA ADVANCED CHIROPRACTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA ADVANCED CHIROPRACTIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548395262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8835 COLUMBIA 100 PKWY
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045-2147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-964-3229
Provider Business Mailing Address Fax Number:
410-964-9671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8835 COLUMBIA 100 PKWY
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-2147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-964-3229
Provider Business Practice Location Address Fax Number:
410-964-9671
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MANISON
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGING MEMBER LLC
Authorized Official Telephone Number:
410-964-3229

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1898PT , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 215131 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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